Weight-based vs. BSA-based Fluid Resuscitation Predictions in Pediatric Burn Patients

Fluid resuscitation for pediatric burns uses formulas that estimate fluid requirements based on weight, and/or body surface area (BSA) along with percent total burn surface area (TBSA). Adult studies have shown that these formulas can cause fluid overload in obese patients and increase risk of complications. These findings have not been validated in pediatric patients. This study provides a retrospective review conducted with 110 children (≤ 18 years old) admitted to an ABA-verified urban pediatric burn center from October 2008 to May 2020. Patients were resuscitated with the weight-based Parkland formula, and had fluids titrated to urine output every two hours. BSA-based Galveston and BSA-incorporated Cincinnati formula resuscitation predictions were also calculated. Complications were collected throughout the hospital stay. Patients were classified into CDC-defined weight groups based on percentile ranges. We found that predicted resuscitation volumes increased as CDC percentile increased for all three formulas (p=0.033, 0.092, 0.038), however there were no significant differences between overweight and obese children. Total fluid administered was higher as CDC percentile increased (p=0.023). However, overweight children received more total fluid than obese children. The difference between total fluids given and Galveston predicted resuscitation volumes were significant across all groups (p=0.042); however, the difference using the Parkland and Cincinnati formulas were not statistically significant. There were more children in the normal weight group who developed complications compared to other groups, but these findings were not significant. Overall, the Parkland formula tended to underpredict fluid needs in the underweight, normal, and overweight children, and it overpredicted fluid needs for the obese. Further research is needed to determine the value of weight-based vs BSA-based or incorporated formulas in terms of their risk of complications

Xeroform gauze is superior to silver sulfadiazine cream in promoting zone of stasis healing for mixed-depth scald burns in children

TITLE: Xeroform gauze is superior to silver sulfadiazine cream in promoting zone of stasis healing for mixed-depth scald burns in children INTRODUCTION: Silver sulfadiazine 1% cream changed daily was historically the mainstay initial treatment at our pediatric burn center. Over recent years, we transitioned to using closed Xeroform dressings (3% bismuth tribromophenate in petrolatum-soaked gauze) in the initial care of partial thickness burns. The purpose of this study is to compare patient outcomes between Xeroform only and silver sulfadiazine. METHODS: A retrospective chart review was conducted of patients age 5 years with mixed-depth scald injuries between: 1) years 2004-2008, when silver sulfadiazine was standard care, and 2) 2015-2018, when Xeroform only had become standard. Data collected included demographics, burn total body surface area (TBSA), length of hospital stay, and necessity, size, and timing of skin grafting. RESULTS: Three hundred forty-seven patients were included, of whom 200 were treated with silver sulfadiazine and 147 with Xeroform only. Burn TBSA and rates of skin grafting were similar between the groups; however, the mean area of the skin graft was significantly smaller for the Xeroform group (147cm2 vs. 336cm2, p=0.027). Of note, time from injury to grafting was significantly longer in the Xeroform group (24d vs. 9.9d, p=0.002), with a larger proportion of these patients returning for outpatient grafting. CONCLUSION: These results suggest that initial treatment with a closed dressing of Xeroform gauze may promote zone of stasis healing resulting in smaller graft sizes compared to silver sulfadiazine cream. Fewer dressing changes combined with later skin grafting could allow burn wounds to demarcate and heal more effectively, benefiting both graft and donor sites

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2\ub75th percentile and 100 as the 97\ub75th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59\ub74 (IQR 35\ub74–67\ub73), ranging from a low of 11\ub76 (95% uncertainty interval 9\ub76–14\ub70) to a high of 84\ub79 (83\ub71–86\ub77). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017.

BACKGROUND: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of 'leaving no one behind', it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment. METHODS: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator

Predictive Factors for Length of Hospital Stay in Pediatric Dog Bite Patients

Title: Predictive Factors for Length of Hospital Stay in Pediatric Dog Bite Patients Authors: Alessio-Bilowus D1, Kumar N2, Ridelman E1, Shanti C21Wayne State University, Detroit, MI; 2Children’s Hospital of Michigan, Detroit, MI Introduction: Dog bite injuries are a source of significant morbidity in the United States, with children being at increased risk compared to adults, yet there is a lack of published data on factors affecting hospital length of stay (LOS) in pediatric patients. Methods: A full-text retrospective chart review was conducted of all patients presenting to our urban, academic pediatric surgery unit for dog bite injuries between January 2016 and May 2021. Multiple demographic and clinical variables were examined prior to, during and after hospital stay. All data was analyzed using IBM SPSS Statistics V22.0 to compare the impact of each variable on hospital LOS. Results: 739 pediatric patients were evaluated and treated for dog bite injuries during the study period, of which 349 were admitted for inpatient care. Hospital length of stay ranged from 1 to 34 days, with a mean of 2.9 days and median of 2.0 days. Our analysis revealed two major predictors of increased length of stay: presence of bone fracture (n = 45, mean LOS = 5.3 days, p = 0.00), and prior medical comorbidity, including infection of the wound prior to the encounter (n = 24, mean LOS = 4.3 days, p = 0.04). Demographic and other clinical variables were not associated with statistically significant increases in LOS. Conclusions: Pediatric patients admitted for dog bite injuries have significantly longer inpatient LOS when they present with bone fractures or significant medical comorbidities including prior wound infection

Ocular Complications of Facial Burns in the Pediatric Population

Introduction: Pediatric burns commonly involve the face and periocular areas, with a possibility of impairing vision. The aim of this study is to characterize ocular injuries in burn patients and identify the patients at most risk of ocular complications. Methods: This study is a retrospective review within a single academic, urban pediatric burn center. All burn patients under 18 years of age admitted from January 2010 to December 2020 with ocular involvement were included. Variables analyzed included patient demographics, burn characteristics, presence of ophthalmology consultation, ocular exam findings, follow up time period, and early and late ocular complications. Results: In the study period, 2,781 patients were admitted to our burn center, 300 of whom had facial burns involving the eyes and/or eyelids. Etiologies of burn injuries were as follows: 112 (37.5%) scald, 80 (26.8%) flame, 35 (11.7%) contact, 31 (10.4%) chemical, 28 (9.4%) grease, and 13 (4.3%) friction. Overall, 70.9% of patients with ocular burns received an ophthalmology consult. Of these patients, 61.5% had periorbital swelling and 39.8% had corneal injuries. Of the 207 patients who were seen by ophthalmology inpatient, only 61 (29.5%) had a follow-up visit as recommended. Among patients seen outpatient, 6 had serious ocular sequelae including ectropion, entropion, symblepharon, and corneal decompensation, 4 of whom had firework-related injury. Conclusion: Burns involving the ocular surface and eyelid margins are at particular risk for long-term damage. As ocular burns can cause immediate as well as delayed sequalae, ophthalmologic evaluation is important in acute and subacute periods after injury